Effect of Parenteral Serum Plant Sterols on Liver Enzymes and Cholesterol Metabolism in a Patient With Short Bowel Syndrome
Effect of Parenteral Serum Plant Sterols on Liver Enzymes and Cholesterol Metabolism in a Patient With Short Bowel Syndrome
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DOI：
10.1177/0884533608321138
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发表时间：
2008-08-01
影响因子：
3.1
通讯作者：
Gylling, Helena
中科院分区：
文献类型：
--
作者：
Hallikainen, Maarit;Huikko, Laura;Gylling, Helena
肝胆并发症在肠外营养期间很常见。市售溶液中的脂质部分含有植物固醇。目前尚不清楚胃肠外营养中的植物甾醇是否会干扰成人的肝功能。我们检测了肠外营养液中不同数量的植物甾醇如何影响短肠综合征患者在1.5年随访期间血清植物甾醇浓度和肝酶。在从Intraperoid（100%大豆基静脉脂肪乳剂）转换为克凌诺（一种含有80%橄榄油、20%大豆油和较低植物甾醇的橄榄油基静脉脂肪乳剂）期间，定期测量血脂、植物甾醇和肝酶水平;脂质供应也从20 g/d逐渐增加至35 g/d。采用气液色谱法测定肠外营养液和血清中的植物甾醇。在输注大豆基静脉脂肪乳剂（30 g/d，总植物甾醇87 mg/d）期间，谷甾醇、菜油甾醇和豆甾醇的浓度分别为4361、1387和378 μ g/dL，血清肝酶值高于正常上限>= 2.5倍。改用橄榄油为基础的静脉脂肪乳剂（20-35 g/d，植物甾醇37-65 mg/d）后，谷甾醇浓度降至2148 - 2251 μ g/dL，菜油甾醇浓度降至569-297 μ g/dL，豆甾醇浓度降至95-55 μ g/dL。同时，随访结束时肝酶值降至正常上限的1.4至1.8倍。患者营养状况改善。脂肪乳剂中植物甾醇的含量对血清肝酶水平的影响大于脂质的含量。(Nutr临床实践2008;23：429-435）
Hepatobiliary complications are common during parenteral nutrition. Lipid moiety in commercially available solutions contains plant sterols. It is not known whether plant sterols in parenteral nutrition interfere with hepatic function in adults. We detected how different amounts of plant sterols in parenteral nutrition solution affected serum plant sterol concentrations and liver enzymes during a 1.5-year follow-up in a patient with short bowel syndrome. Serum lipid, plant sterol, and liver enzyme levels were measured regularly during the transition from Intralipid (100% soy-based intravenous fat emulsion) to ClinOleic (an olive oil-based intravenous fat emulsion with 80% olive oil, 20% soy oil and lower plant sterols); the lipid supply was also gradually increased from 20 to 35 g/d. Plant sterols in parenteral nutrition solution and serum were measured with gas-liquid chromatography. During infusion of soy-based intravenous fat emulsion (30 g/d, total plant sterols 87 mg/d), the concentrations of sitosterol, campesterol, and stigmasterol were 4361, 1387, and 378 mu g/dL, respectively, and serum liver enzyme values were >= 2.5 times above upper limit of normal. After changing to olive oil-based intravenous fat emulsion (20-35 g/d, plant sterols 37-65 mg/d), concentrations decreased to 2148 to 2251 mu g/dL for sitosterol, 569-297 mu g/dL for campesterol, and 95-55 mu g/dL for stigmasterol. Concomitantly, liver enzyme values decreased to 1.4 to 1.8 times above upper limit of normal at the end of follow-up. The nutrition status of the patient improved. The amount of plant sterols in lipid emulsion affects serum liver enzyme levels more than the amount of lipid. (Nutr Clin Pract. 2008;23:429-435)